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<br /> 1 ®
<br /> ® �� = � NON - COLLUSION AFFIDAVIT
<br /> ® u '. I
<br /> City of Sunny Isles Beach
<br /> Ai-
<br /> ';99 _ 18070 Collins Avenue
<br /> Si C' ,•"FLORA o+�` Sunny Isles Beach,FL 33160
<br /> 5 ''`o, sos"a Telephone:(305)947-0606 Fax:(305)949-3113
<br /> S
<br /> STATE OF FLORIDA )
<br /> ®
<br /> ® COUNTY OF Ml►aeN e
<br /> ® The undersigned being first duly sworn as provided by law,deposes,and says:
<br /> ® This Affidavit is made with the knowledge and intent that it is to be filed with the City of Sunny Isles Beach City Commission and that it will be
<br /> ® relied upon by said County,in any consideration which may give to and any action it may take with respect to this Bid.
<br /> The undersigned is authorized to make this Affidavit on behalf of,
<br /> ®
<br /> 0 )nen --N11)(1 (OVA
<br /> ( ame of Corporation,Partnership,I ividual,etc.')
<br /> •
<br /> ® a, TOM RCAiness) ,formed under the laws of :101 1.=:1=n(Type of (State)
<br /> • \/
<br /> of which he is V ( Cf -Pres i.==.\``-et'-Ni"
<br /> (Sole Owner,Partner,President,etc.)
<br /> O Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the
<br /> undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City,also that no head of any
<br /> ® department or employee therein,or any officer of the City of Sunny Isles Beach,Florida is directly interested therein.
<br /> ® This Bid is genuine and not collusive or a sham;the person,firm or corporation named above in Paragraph 10.2 has not colluded,conspired,
<br /> connived or agreed directly or indirectly with any proposers or person,firm or corporation, to put in a sham Bid,or that such person,firm or
<br /> 0 corporation,shall refrain from Bidding,and has not in any manner,directly or indirectly,sought by agreement or collusion,or communication
<br /> or conference with any person,firm or corporation,to fix the prices of said Bid or Bids of any other proposers;and all statements contained in
<br /> ® the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph
<br /> 10.2,has directly or indirectly submitted said Bid or the contents thereof,or divulged information or data relative thereto,to any association or
<br /> O to any member or agent thereof.
<br /> ® T k mcch hR 01/4V,1I \1 P •
<br /> 0 AFFIANT'S NAME AFFIANT'S TITLE
<br /> ® TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this'this 46 day of tleCe. - bec- ,201-1.
<br /> 0 Personally Known or Produced Identification ,
<br /> 0 Type of identification
<br /> (Affix seal here) /
<br /> ® 4Ir,o,\b\\\e
<br /> NOTARY PUBLIC(n =printed o..-ped)
<br /> • •► -7.
<br /> r.:"Yhsi ANA VALLE
<br /> •r_ MY COMMISSION I FF 069572
<br /> ..iii EXPIRES:February 4,2018
<br /> ', r Bonded Duo Notary Publc Undewnlera
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